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Baby better at breast, but hopsital measures bottles

My baby is a 32-weeker and still in the "special care nursery" which is NICU for babies that are healthy but learning to feed. She has been there three weeks. My daughter does well at the breast (10 minutes each side and no supplement after, sleeps through to next feeding) but gets tired out with bottle feedings at the hospital because she has a very strong suck and the milk flows from the bottles too fast. Because of that she takes very little from a bottle, though she can nurse from me and be satisfied. They said today they will try a special extremely slow flow nipple. She has gained lots of weight, so much that they have lowered the fortification to 22 cal from 24. She was born 5 lb 14 oz, lost 7 oz the first week, and as of yesterday she weighs 6 lbs 10 oz. This is very draining. I want her to come home, but I don't know how to help her. Some of the staff is very helpful and supportive, while I feel others just treat her and me as "one size fits all". I feel like if she came home, she would eat enough. My production has been excellent, I eat well and take awesome vitamins, and I drink plenty of water. Of course, I'm not a doctor and don't know all the factors in their decision-making, I just want what's best for my baby.

Re: Baby better at breast, but hopsital measures bottles

It's wonderful that your baby is doing so well! I'm sorry she hasn't been allowed home yet. I think I would want to talk to her primary doctor- IDK if that would be a pediatrician or someone in the NICU- and discuss exactly what they want to see before they'll let her go home. Is it only a weight/feeding issue, or are there additional concerns which should keep the baby in the hospital?

If the only issue is baby's weight/feeding, you might want to consider offering some alternatives that could allow for close Home monitoring of her intake and weight gain. Like having a professional baby scale at home with you, and doing before/after feeding weights (subtract the before from the after and you get an accurate picture of how much baby ate while nursing) or at least weighing the baby every day.

Re: Baby better at breast, but hopsital measures bottles

They are looking for her to take her full feedings from a bottle (my breast milk plus fortifier) as well as nursing at least 20 minutes total. I think they prefer the bottles so they can measure milliliters. I have expressed repeatedly that it is my desire to transition to EBF, and that I have great milk production, and that I am an experienced mom who nursed my other children to two years each. She has a great latch when she is not exhausted, and she can be heard sucking effectively and swallowing. I just called them this morning and heard that she lost 2 ounces-yesterday they tried bottle feeding her nearly every feeding, and I am sure that she expended a lot of calories trying to manage the bottle's flow. But then I can't be in the hospital 24/7. I wonder if they would consent to the professional baby scale, I think that is a great idea. I am going there later today.

Re: Baby better at breast, but hopsital measures bottles

I haven't had a premature baby, but my first child was hospitalized with severe jaundice, so I at least know the frustration of getting so many different people making decisions about your child, some of whom don't seem to see you as a person with unique needs.

One thing I would suggest is find the one doctor that you think is most authoritative and understands about breastfeeding and express your concerns to them. I found when some of the nurses etc. were pushing us to give my son more formula, it only took one person who knew what they were talking about to argue that getting more breastmilk in him was a better way to go. That person was able to argue the case to the other doctors (who were less informed) and give the nurses more clear instructions.

Re: Baby better at breast, but hopsital measures bottles

If all else fails, and you feel like your needs are not being addressed, some hospitals have an ombudsman type of person who you can talk to that can help you to talk with the doctors about your concerns. It's true that the doctors are more informed than you, but they are still working for YOU. If you're not satisfied that they're doing the right thing for your child, you have a right (I'd say an obligation) to keep asking questions and making demands until you are comfortable with the choice of treatment. Hang in there!!! It sounds like things are improving for you child. You'll get through this.

Re: Baby better at breast, but hopsital measures bottles

The only reason that I can see that they wouldn't let her go would be if you are planning on bottle feeding her once she gets out of the hospital. If you are then it would be a good idea to make sure she will tolerate the bottles.

If they have mentioned the premie nipple flow/ultra slow whatever and still haven't tried that with her yet demand they do it for the next feeding and stop wasting time. That is horse crap that it hasn't been tried yet. Some other things to consider: She should be fed in a side lying position to mimmic BFing, the presentation of the bottle, in other words giving her breaks etc., and volume; many NICUs are volume driven rather than cue based. It is only recently that NICUs are taking notice of these issues. Try youtubing some videos. I like this one http://www.youtube.com/watch?v=Bl_hNk3NoC4 A NICU trained speech therapist or occupational therapist should be helping with this process. Some nurses are very knowledgeable but many more are not and although well meaning have no clue what they are doing.

Oh and another thing is do NOT do NOT let anyone go moving, swirling, vigorously 'stimulating' the nipple in her mouth this is more than counter productive it can be harmful.

If you are planning on only BFing upon her discharge I would really push for the home weight checks and be done with it. Or ask for a transfer to a hospital with staff that can help but research which you want to transfer to and request that one.

Married to the best husband ever since Nov 2009
DS born 1/7/12 at 36 wks after PROM and Gestational diabetes happy and healthy ~

Re: Baby better at breast, but hopsital measures bottles

Thanks to everyone for input. Update-they have switched to the extra-slow-flow nipple which baby does better with, and the doctor has written an order to go "cue-based" on baby rather than volume based, from the occupational therapist's recommendation. If she nurses well for at least 10 minutes, they tube feed her half of the volume recommended for her. If she nurses well for 15 minutes or more, they do not supplement for that feeding and wait until she wakes up hungry-at those times she has made it 3 hours on a breastfeeding. The OT has also recommended I use a nipple shield for now so that baby gets more for her efforts, and it has helped, she definitely got more milk from me that way. Doctor says that she may be ready to go home as soon as a week, or it could take another few weeks. Hopefully these measures will help her develop the consistency they are looking for, and that everyone will be more helpful now that I speak up for myself and baby more. Every time I go there I have to remind new nurses I am working toward EBF and that they should not try a bottle immediately after breastfeeding if she didn't feed long enough; thankfully the therapists are also lactation consultants, and they are advocating for me with the doctor. I will look into side-lying bottle feeding-funny, my husband reasoned just yesterday that maybe they should feed her on her side when I can't be there.

Re: Baby better at breast, but hopsital measures bottles

Thanks for the update! I'm glad to hear that you feel like the hospital staff is listening to you.

My one concern would be the shield. One big problem with nipple shields is that they can slow/reduce milk transfer, due to decreased stimulation to the breast from baby's mouth. Therefore, shields are generally best used for babies who have trouble latching without them, not for babies who latch okay but have trouble getting milk when latched. If you feel like the baby gets more milk with the shield, that's fine. But I would probably want to confirm this using a professional scale. Do some before-and-after weights with the shield and without, and see if there is a real difference between the shield vs. non-shield sessions.